Abstract
Successful anterior cruciate ligament reconstruction with a tendon graft necessitates solid healing of the tendon graft in the bone tunnel. Improvement of graft healing to bone is crucial for facilitating an early and aggressive rehabilitation and ensuring rapid return to pre-injury levels activity. Tendon graft healing in a bone tunnel requires bone ingrowth into the tendon. Indirect Sharpey fiber formation and direct fibrocartilage fixation confer different anchorage strength and interface properties at the tendon-bone interface. For enhancing tendon graft-to-bone healing, we introduce a strategy that includes the use of periosteum, hydrogel supplemented with periosteal progenitor cells and bone morphogenetic protein-2, and a periosteal progenitor cell sheet. Future studies include the use of cytokines, gene therapy, stem cells, platelet-rich plasma, and mechanical stress for tendon-to-bone healing. These strategies are currently under investigation, and will be applied in the clinical setting in the near future.
Highlights
One of the most challenging and important problems physicians are facing is the failure of anterior cruciate ligament (ACL) reconstruction after injury and primary surgical repair [1,2,3,4]
The tendon-to-bone healing in a bone tunnel occurs by bone ingrowth into the fibrovascular interface tissue that initially forms between the tendon and the bone
We evaluated the effect of periosteum-enveloping tendon graft on tendon-to-bone healing in two different experimental models in rabbits: periosteum-enveloping tendon graft in a bone tunnel, and periosteum-enveloping tendon graft in ACL reconstruction [38,39]
Summary
Current techniques of ACL graft reconstruction require healing of a tendon graft in a bone tunnel. Adequate and earlier tendon-to-bone healing may solve this problem This technique may be applied to ACL reconstruction to enhance the tendon graft healing within the tunnel. In order to enhance the tendon-to-bone tunnel healing, our laboratory intended to develop an injectable hydrogel to fill the tendon-bone tunnel interface in a tissue-engineering approach. In part, mimic the structure and biological function of an extracellular matrix They should promote cell proliferation, induce cell differentiation or enhance the growth of surrounding tissues. Our study suggests that photoencapsulation of BMP-2 and PPCs has the ability to improve the healing between the tendon and the bone This technique may provide a novel platform for tissue-engineered stem cell therapy. The PPC sheets could act as periosteum to offer a novel approach to enhance the healing at the tendon-bone junction
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